Mental Impairment Claims - Intelligence Quotient (IQ) - Can You Prove the Client's Listing IQ?
The mental disorder listing for 12.05 is:
12.05 Mental retardation: Mental retardation refers to significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22.
The required level of severity for this disorder is met when the requirements in A, B, C, or D are satisfied.
A. Mental incapacity evidenced by dependence upon others for personal needs (e.g., toileting, eating, dressing, or bathing) and inability to follow directions, such that the use of standardized measures of intellectual functioning is precluded;
B. A valid verbal, performance, or full scale IQ of 59 or less;
C. A valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function;
D. A valid verbal, performance, or full scale IQ of 60 through 70, resulting in at least two of the following:
- Marked restriction of activities of daily living; or
- Marked difficulties in maintaining social functioning; or
- Marked difficulties in maintaining concentration, persistence, or pace; or
- Repeated episodes of decompensation, each of extended duration.
The basis of this listing is to award benefits to claimants who meet SSA’s definition of mental retardation. Its is important to note that Social Security has its own definition for mental retardation, separate and apart from the definition of mental retardation found in the Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994), published by the American Psychiatric Association. In fact, the Commissioner rejected a proposal that the DSM’s definition be used for Listing 12.05.1 It is also important to note that it is not necessary, in order to meet 12.05 introductory language, for a formal diagnosis of mental retardation to have been made.2
For Social Security disability purposes, the term “mental retardation” means having significantly sub-average general intellectual functioning along with defects in adaptive functioning. These defects must have been manifested initially during the developmental period, that is, before age 22.
The intellectual functioning part is measured by IQ scores. The two tests which are typically utilized to measure intellectual performance are the Wechsler Adult Intelligence Scale (WAIS) and the Stanford-Binet. On any IQ test, SSA must use the lowest valid IQ score. It is commonly understood the IQ scores stabilize in childhood.
As to 12.05 A. if the claimant is dependent on others for personal needs and cannot follow directions so that he/she ahs an inability to take a test designed to measure intellectual functioning, then part 1 of this listing has been met.
As to 12.05 B. if the IQ score is 59 or less for any of the three subsets (verbal, performance or full scale) then part 1 of this listing has been met.
As to 12.05 C. if the IQ score is 60 through 70 for any of the three subtests and the claimant has either a mental or physical mental impairment that imposes a significant work related limitation of function, then part 1 of this listing has been met. There has been much litigation regarding what constitutes “a significant work related limitation of function.” Logically, it does not mean a limitation that is so significant that it would, by itself, disable a claimant. If it meant that, then there would be no need to refer to the IQ scores. Therefore, a significant work related limitation of function must mean something less than a limitation that would result in disability by itself. The majority of the Federal Circuits have held that any impairment which has more than a minimal effect on the claimant’s ability to work constitutes a significant limitation. The Seventh Circuit has not yet ruled on this specific issue. However, one U.S. District Court in Wisconsin has addressed this issue. It ruled that the second prong of Listing 12.05, that the claimant’s impairment impose a significant work-related limitation of function, is met if the claimant’s impairments had more than a slight or minimal effect on her ability to work. Magray v. Shalala, 880 F. Supp. 1278 (E.D. Wis. 1995).
A U. S. District Court in Pennsylvania3 recently explained the concept of GAF scale as follows:
The Global Assessment of Functioning Scale (“GAF”) assesses an individual's psychological, social and occupational functioning with a score of 1 being the lowest and a score of 100 being the highest. The GAF score considers “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 34 (4th ed.2000). An individual with a GAF score of 60 may have “[m]oderate symptoms” or “moderate difficulty in social, occupational, or school functioning;” of 50 may have “[s]erious symptoms (e.g., suicidal ideation ....)” or “impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job);” of 40 may have “[s]ome impairment in reality testing or communication” or “major impairment in several areas, such as work or school, family relations, judgment, thinking or mood; of 30 may have behavior “considerably influenced by delusions or hallucinations” or “serious impairment in communication or judgment (e.g., ... suicidal preoccupation)” or “inability to function in almost all areas ...; of 20 “[s]ome danger of hurting self or others ... or occasionally fails to maintain minimal personal hygiene ... or gross impairment in communication.”
GAF scores can be very beneficial to claimants when the scores are low. However, not all psychologists who testify at ODAR hearings and ALJ who decide cases like to consider GAF scores relevant to the determination of disability. Recently, a psychologist at an ODAR hearing refused to testify as to the possible vocational implications of low GAF scores contending that they had no meaning in legal proceedings.
The Commissioner has a standard position with regard to low GAF scores. That position is: (1) GAF ratings have no direct legal or medical correlation to the Commissioner's finding on the issue of disability; (2) a GAF score does not indicate how long the symptoms or limitations will last; (3) the ALJ specifically addressed Plaintiff's mental status during the relevant time period and accounted for all of her proven mental functional limitations in her RFC assessment; (4) GAF scores of 42-50 do not automatically translate into a finding that Plaintiff had work-preclusive mental limitations; and (5) the ALJ was not required to specifically address Plaintiff's GAF scores of 50 and below because the overwhelming evidence of record discounted their probative value, rendering the GAF scores irrelevant.
The Seventh Circuit has ruled that the ALJ is not bound by the GAF score in assessing the extent of a claimant’s disability. The court ruled that GAF scores are:
“useful for planning treatment,” and are measures of both severity of symptoms and functional level. Id. at 32. Because the “final GAF rating always reflects the worse of the two,” id. at 33, the score does not reflect the clinician's opinion of functional capacity. Accordingly, “nowhere do the Social Security regulations or case law require an ALJ to determine the extent of an individual's disability based entirely on his GAF score.”
Denton v. Astrue, 596 F.3d 419, 425 (7th Cir 2010) . That said, the U.S. District courts in this Circuit have ruled that GAF scores “is one more piece of highly relevant evidence” which cannot be ignored by an ALJ. Lopez v. Astrue Slip Copy 2012, 426899 N.D. Il., 2012, page 9.
1 See 67 Fed. Reg. 20,022
2 Maresh v. Barnhart, 438 F.3d 897, 899 (8th Cir. 2006); Christner v. Astrue, 498 F.3d 790, 793 (8th Cir. 2007)
3 Debaise v. Astrue, 2010 WL 597488, at *5 n. 7 (W.D.Pa. Feb.16, 2010)